International Journal of Research in Orthopaedicshttps://www.ijoro.org/index.php/ijoro
<p><img style="display: inline; margin: 6px;" src="/public/site/images/medip/Big_Cover.png" alt="" width="145" height="190" align="left" /><br />International <span>Journal of Research in Orthopaedics is an open access, international, peer-reviewed journal that publishes original research work across all disciplines of orthopaedics and allied sciences. The journal's full text is available online at http://www.ijoro.org. The journal allows free access to its contents. The journal aims to provide a platform for the exchange of information about all areas of orthopaedics and to promote the discipline of orthopaedics throughout the world. International Journal of Research in Orthopaedics is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, analytic reviews such as meta-analyses, insightful editorials, medical news, case reports, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new techniques. It is published <span>every two months </span>and available in print and online version. International Journal of Research in Orthopaedics complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors</span>.</p><p><strong>Issues: 6 per year</strong></p><p><strong>Email: <a href="mailto:editorijoro@gmail.com" target="_blank">editorijoro@gmail.com</a>, <a href="mailto:editor@ijoro.org" target="_blank">editor@ijoro.org</a></strong></p><p><strong>Publisher:</strong> <a href="http://www.medipacademy.com/" target="_blank"><strong>Medip Academy</strong></a></p><p><strong>DOI prefix: 10.18203</strong></p><p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="http://www.crossref.org/" target="_blank">CrossRef (DOI)</a></p><p> </p><p><strong>Manuscript Submission</strong></p><p>International Journal of Research in Orthopaedics accepts manuscript submissions through <a href="/index.php/ijoro/about/submissions#onlineSubmissions" target="_blank">Online Submissions</a>:</p><p>About the Journal &gt; <a title="Online Submissions" href="/index.php/ijoro/about/submissions#onlineSubmissions" target="_blank">Online Submissions</a></p><p>Registration and login are required to submit items online and to check the status of current submissions.</p><p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="mailto:editor@ijoro.org" target="_blank">editor@ijoro.org</a></p><p> </p><p><strong>Abbreviation</strong></p><p>The correct abbreviation for abstracting and indexing purposes is Int J Res Orthop.</p><p><strong><br /></strong></p><p><strong>Abstracting and Indexing information</strong></p><p>The journal is indexed with <a href="https://journals.indexcopernicus.com/search/journal/issue?issueId=all&amp;journalId=44185" target="_blank">Index Copernicus</a>, <a href="http://www.crossref.org/titleList/" target="_blank">CrossRef</a>, <a title="LOCKSS" href="/index.php/ijoro/gateway/lockss" target="_blank">LOCKSS</a>, <a href="https://scholar.google.co.in/" target="_blank">Google Scholar</a>, <a href="http://www.icmje.org/journals-following-the-icmje-recommendations/" target="_blank">ICMJE</a>, <a href="http://jgateplus.com/search/login/" target="_blank">J-Gate</a>, <a href="http://www.journaltocs.ac.uk/index.php?action=browse&amp;subAction=pub&amp;publisherID=3072&amp;local_page=1&amp;sorType=&amp;sorCol=1&amp;pageb=1" target="_blank">JournalTOCs</a> and <a href="http://journalseeker.researchbib.com/view/issn/2455-4510" target="_blank">ResearchBib</a>.</p><p><strong><strong><a href="https://journals.indexcopernicus.com/search/journal/issue?issueId=all&amp;journalId=44185" target="_blank">Index Copernicus Value</a>: <strong><strong><strong><strong><strong><strong>ICV 2018: 100.00</strong></strong></strong></strong></strong></strong><strong>, </strong><strong><strong><strong><strong>ICV 2017: 100.00</strong></strong></strong></strong><strong><strong><strong><strong>, </strong></strong></strong></strong><strong><strong>ICV 2016: 84.72</strong></strong></strong></strong><strong><strong><strong><strong>, </strong>ICV 2015: 81.02</strong></strong></strong></p>Medip Academyen-USInternational Journal of Research in Orthopaedics2455-4510

Effectiveness of combined magnetic field bone growth stimulation on lumbar spinal fusion outcomes: a single center retrospective analysis comparing combined magnetic field to no-stimulationhttps://www.ijoro.org/index.php/ijoro/article/view/1500
<p class="abstract"><strong>Background:</strong> The objective of this retrospective study was to assess the effect of combined magnetic field (CMF) bone growth stimulation on lumbar fusion outcomes, as compared to no-stimulation.</p><p class="abstract"><strong>Methods:</strong> This study reviewed fusion efficacy of a consecutive cohort of 652 patients who underwent lumbar fusion surgery at our institution between 2001 and 2018. Fusion status was determined via radiographic analysis, with four surgeons contributing data to this study. The minimum patient follow-up time was 6 months. Previously identified risk factors (i.e. smoking status) were also collected. Statistical analysis was performed using cross-tabulation tests with chi-square analyses, one-way ANOVA’s, and Tukey’s range tests. 53% (343/652) of patients had undergone adjuvant treatment with CMF stimulation.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients treated with CMF stimulation had significantly greater fusion success of 97% compared to no stimulation at 62% (p&lt;0.00001). Further, it was observed that smokers had a significantly higher fusion rate with CMF treatment than without electrical stimulation (94% vs 61%, p=0.000032).</p><p class="abstract"><strong>Conclusions:</strong> Additional studies to evaluate the effectiveness of CMF treatment in patients with risk factors are warranted.</p>Ramin RaiszadehKamshad RaiszadehLaura EatonPaul KimCholl Kim
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226343544110.18203/issn.2455-4510.IntJResOrthop20201062Septic arthritis of ankle joint in the paediatric age group: a retrospective studyhttps://www.ijoro.org/index.php/ijoro/article/view/1459
<p class="abstract"><strong>Background:</strong> Septic arthritis in paediatric age group poses a significant clinical problem. Common sites are hip and knee joint. There are several orthopaedic literatures available on septic arthritis of the hip and knee joint, however, literature on epidemiology, causative organisms and outcome of septic arthritis of the ankle are very few.</p><p class="abstract"><strong>Methods:</strong> We conducted a retrospective study at a tertiary hospital with an aim to evaluate the incidence, causative pathogen, outcome and to identify differences, if any, between clinical features and laboratory findings of these patients when compared to those with hip and knee joint infection.<strong></strong></p><p class="abstract"><strong>Results:</strong> 47 children were diagnosed with septic arthritis, of which, 14 had septic arthritis of the ankle. Mean age was 5.2 years (8 months - 12 years). 13 children had undergone joint aspiration as a primary procedure. 50% (7) children had positive culture. <em>Streptococcus pyogenes</em> was the commonest causative organism in our cohort (29%) followed by <em>Staphylococcus aureus</em>. Mean follow-up was 36 months (16 - 56 months). 13 children (93%) had good clinical outcome. 1 child developed early arthritis.</p><p class="abstract"><strong>Conclusions:</strong> Septic arthritis of the ankle is a serious condition. Even-though the joint is superficial, diagnosing it clinically can be difficult due to less pronounced symptoms. This can lead to delay in establishing the diagnosis and commencing treatment, hence, it is imperative to have a high index of suspicion. We found early joint aspiration followed by a course of antibiotics to be an effective regimen in management of this devastating condition.</p>Nasiur RehmanMarcin ZgodaMohamed K. Osman
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226344244610.18203/issn.2455-4510.IntJResOrthop20201016Functional outcome of tibial plateau fracture managed conservativelyhttps://www.ijoro.org/index.php/ijoro/article/view/1413
<p class="abstract"><strong>Background:</strong> Tibial plateau fractures involve the articular surface of the proximal tibia. They account for approximately 1% of adult fractures. A number of articles have been published regarding tibial plateau fracture management. Interestingly excellent results have been published concluding not all fractures of the tibial plateau require surgery and not all displaced intra-articular fractures need to be reduced surgically. In this method we used conservative method to restore normal joint anatomy, joint stability, and functional motion and avoid complications.</p><p class="abstract"><strong>Methods:</strong> This study design is prospective study including forty randomly selected cases of diagnosed tibial plateau fracture presented in Orthopaedic department of tertiary referral centre over 18 months period and treated with conservative method. The patients then were followed up and evaluation of outcome was analyzed as per modified Rasmussen clinical criteria and radiological criteria at six months.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study, tibial plateau fracture was seen more in patients of age group 31-40 (35%). Mean age being 41.25 years. There were 28 (70%) male and 12 (30%) female. Road traffic accident comprises the majority of cases (75%). Regarding radiological outcome, 41.5% had excellent result, 34.3% had good result, 8.5% had fair result and 15.7% had poor result. 84% had acceptable outcome. The Rasmussen’s functional outcome at final follow up was 46% patients had excellent result, 30% had good result, 12% had fair result and 12% had poor result. 88% had acceptable clinical outcome.</p><p class="abstract"><strong>Conclusions:</strong> Conservative management of tibial plateau is still a reliable, inexpensive and alternative treatment option with favourable functional outcome.</p>Anubhav RijalAashish Rajthala
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226344745010.18203/issn.2455-4510.IntJResOrthop20201721Clinical treatment of femoral head using Thompson hip prosthesishttps://www.ijoro.org/index.php/ijoro/article/view/1483
<p class="abstract"><strong>Background:</strong> Hip prosthesis is a successful surgical technique the treatment of hip joint fracture. Thompson hip prosthesis is commonly used treatment of femoral head fracture. It is designed for non-union of fracture neck of femur when there is no neck available.</p><p class="abstract"><strong>Methods:</strong> In this retrospective study, examined the results of patients with Thompson hip prosthesis (cemented and uncemented). This examination has been done from August 2014 to February 2016. 50 Patients were enrolled in this study with mean age of 70 years in which the ratio of number of females more than the number of males. AO classification was used to categorize the hip fracture type. Patient physical fitness was obtained through visual analog scale. Thompson hip prosthesis has been used to treatment of femoral head fracture, manufactured at Auxein Medical Pvt. Ltd., Sonipat, Haryana, India.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients were follow-up on six week and three-month after discharge from hospital. 90% patients have excellent or pain-free results. There is no implant related complication has been found such as Loosening, prosthesis related size. The overall performance of hip prosthesis was very good.</p><p class="abstract"><strong>Conclusions:</strong> Present guideline strongly favor of hip prosthesis. After clinical study, we can conclude that the Thompson hip prosthesis is the best technique to treatment of femoral head fracture. Thompson is also a quick, simple, palliative solution to early mobility.</p>Pooja RawatMohit KumarGaurav LuthraAnkit Katiyar
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226345145410.18203/issn.2455-4510.IntJResOrthop20201089Randomised prospective comparative analysis of functional outcome of hemiarthroplasty with cemented bipolar and uncemented unipolar prosthesishttps://www.ijoro.org/index.php/ijoro/article/view/1526
<p class="abstract"><strong>Background:</strong> Hemiarthroplasty (HA) has been considered as better treatment modality in elderly patients compared to internal fixation because of better outcome, early mobilization, associated with HA. However, there is inadequate evidence to support the choice between unipolar or bipolar HA. The aim of this study was to compare the outcome of uncemented unipolar with the cemented bipolar prosthesis in geriatric patients especially in an Indian setup.</p><p class="abstract"><strong>Methods:</strong> Sixty five patients above 60 years of age and displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar or bipolar HA, in the Department of Orthopaedics, between September 2014 and October 2016. Functional outcome was assessed and compared using Harris hip score and radiological parameters with X-ray with serial follow-up at 3, 6, 12 and 18 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> The two groups of patients with mean age of 68±7 years in bipolar group and 68±6 years in unipolar group did not differ in their pre-injury characteristics and perioperative parameters. The mean Harris hip score in cemented bipolar and uncemented unipolar groups was 86±8.53 and 85.27±10.09, respectively (p=0.687). There were no differences in functional activities either group.</p><p class="abstract"><strong>Conclusions:</strong> Based on the results of our study, there appears to be no statistical difference between the two groups, uncemented unipolar HA and cemented bipolar HA in terms of functional outcome and various complications discussed. Uncemented unipolar HA is cheap, less technically demanding, suitable in fragile old patients.</p>Hashmukh S. VarmaSachin UpadhyayNuthan Jagadeesh
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226345546110.18203/issn.2455-4510.IntJResOrthop20201519Study of surgical management of fracture of proximal humerus by PHILOS plate and screwshttps://www.ijoro.org/index.php/ijoro/article/view/1471
<p class="abstract"><strong>Background:</strong> Proximal humerus fracture accounts for about 5% of all fractures in recent advances proximal humerus fractures are often managed operatively with PHILOS plate which provides greater angular stability and study was aimed at to assess functional outcome of PHILOS plate fixation in proximal humerus fractures.</p><p class="abstract"><strong>Methods:</strong> Prospective study of 31 cases of proximal humerus fractures admitted and operated in Kempegowda Institute of Medical Sciences Hospital November 2017 to May 2019 of which 4 patients died due to medical comorbidities so 27 patients were studied. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Constant and Murley (CM) scoring and disabilities of the arm, shoulder and hand (DASH) scoring.<strong></strong></p><p class="abstract"><strong>Results:</strong> CM scoring and DASH scoring was applied to analyze the functional outcome among the cases. Most of the patients had excellent outcome (52%) followed by good (26%), fair (8%) and poor (15%) outcome according to CM scoring and according to DASH scoring 20.21 was mean score and mean CM score was 77.62. Complications observed were impingement in 1 patient, avascular necrosis in 2 patient and non union in 1 case.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that the use of PHILOS plate for the fixation of proximal humerus fractures is a good device as it provides rigid fixation and early mobilisation and prevented complications. Precontoured locking plates work on the principle of angular stability, divergent screws, less disruption of vascularity and less chances of plate failure.</p>Channappa T. SeetharamManju JayaramShivakumar H. BachhappaYatish RamalingaiahSyed Abdul Hadi
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226346246610.18203/issn.2455-4510.IntJResOrthop20201722Functional outcome evaluation of distal humerus fracture fixationhttps://www.ijoro.org/index.php/ijoro/article/view/1486
<p class="abstract"><strong>Background:</strong> Distal humerus fracture are complex, difficult to reduce and fix, cumbersome post-operative mobilization, and yet functional outcome is doubtful. Though various treatment modalities available for past many decades ranging from conservative management, K wire fixation to plate and screws, but still treatment remains difficult. The objective of the study was to assess functional outcome of operative fixation of distal humerus with locking plate and screws.</p><p class="abstract"><strong>Methods:</strong> Prospective study was done in during November 2015 to June 2016 in Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. Patients with distal humerus fractures who were admitted into hospital for operative treatment after fulfilling inclusion and exclusion criteria were included into study. They were followed up to 6 months post-operatively. Functional outcome evaluation was done with Mayo’s elbow performance score.<strong></strong></p><p class="abstract"><strong>Results:</strong> 30 patients were included into study with full data. We had excellent, good, fair and poor outcome in 17, 8, 3, 2 patients respectively. Except for infection in one, elbow stiffness in two and non-union in two patients, we had no other complications.</p><p class="abstract"><strong>Conclusions:</strong> Management of distal humerus fractures with preoperative evaluation, pre-operative planning, use of locking plate and screws, early mobilization can result in good functional outcome.</p>Boddu SunilSandeep Krishna AvulapatiSuraj Kumar ChoudharySusmitha Koneru
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226346747010.18203/issn.2455-4510.IntJResOrthop20201017Clinical outcome of treatment of intra-articular distal humerus fracture with open reduction and internal fixation by orthogonal locking plate: a prospective studyhttps://www.ijoro.org/index.php/ijoro/article/view/1458
<p class="abstract"><strong>Background:</strong> The aim of the study was to study the clinical outcome and complications of surgical management of intra-articular fractures of distal humerus.</p><p class="abstract"><strong>Methods:</strong> A prospective study included 23 consented patients with intra-articular distal humeral fractures who underwent osteosynthesis by orthogonal locking compression plating using posterior approach with olecranon osteotomy between November 2017 to May 2019 at BLDE(DU’s) Shri BM Patil Medical College, Vijayapura, Karnataka.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study there were 15 male patients and 8 female patients with mean age of 38.5 years. 65.2% of the cases admitted were due to motor vehicle accident, 21.7% due to accidental fall and 13% due to fall from height with right side (73.9%) being the more commonly affected side. The mean operative time was 100 minutes. Mayo Elbow Performance Score was 83.3% post operatively and the mean arc of motion was 117°. 82% of cases fared excellent to good results.</p><p class="abstract"><strong>Conclusions:</strong> Orthogonal locking plate construct provides stable rigid fixation for allowing early mobilisation and allows predictable healing both clinically and functionally in these complicated fractures. Absence of implant failure and non-union may be attributed to the highly stable construct system achieved by orthogonal locking plating. Majority of our cases had good functional outcome and return to pre injury status.</p>Deepak VashisthaSandeep NaikSantosh NandiShreepad Kulkarni
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226347147610.18203/issn.2455-4510.IntJResOrthop20201030Intensive care unit delirium - does prolonged intensive care unit stay increase morbidityhttps://www.ijoro.org/index.php/ijoro/article/view/1320
<p class="abstract"><strong>Background:</strong> The term intensive care unit (ICU) delirium or ICU psychosis denotes the transient period of psychosis exhibited by the geriatric patients placed in long term ICU care. This condition can be mistaken for organic neurological deterioration and can result in improper treatment, delayed rehabilitation and longer ICU stay. The objective of the study was to analyse the outcome of early ward rehabilitation in post-surgical patients with ICU psychosis.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective case control study of 45 geriatric patients (above 60 years of age) who developed delirium or psychosis after long term ICU stay (&gt;4 days) following a major trauma and orthopaedic procedure. Of the 45 patients, 28 patients (group A) were shifted out of ICU after haemodynamic stability despite continued delirious episodes. The remaining 17 patients (group B) were those who were retained in the ICU for complete neurological recovery.<strong></strong></p><p class="abstract"><strong>Results:</strong> Significant positive difference was noted in patients who were shifted out of ICU early (group A) compared to group B. Group A patients had faster recovery, lesser delirious episodes (2.3±0.9 compared to 13.4±2.7) and fewer days of hospital stay (4.9±1.2 compared to 12.4±2.6) when compared to group B. None of the patients had any episodes of psychosis after discharge from the hospital when followed up for duration of 6 months.</p><p class="abstract"><strong>Conclusions:</strong> Post-operative geriatric patients diagnosed with ICU psychosis fare better with early out of ICU mobilisation. It is not essential to wait for full neurological recovery to shift these patients out of ICU though close ward monitoring may be essential in some cases.</p>Niranjanan Raghavn MuralidharagopalanKamalakumar KaruppasamySomasundaram Subramanian
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226347747910.18203/issn.2455-4510.IntJResOrthop20201061An evaluation of congenital talipes equinovarus patients treated by various methodshttps://www.ijoro.org/index.php/ijoro/article/view/1217
<p class="abstract"><strong>Background:</strong> Idiopathic congenital talipes equinovarus is one of the commonest congenital anomaly. Although treatment provides many options, near universal agreement exists that initial management should consist of gentle manipulation of the affected foot. In developing country like India presentation is extremely variable from soon after birth to very late childhood and irregular follow up makes treatment more difficult.</p><p class="abstract"><strong>Methods:</strong> 100 cases of congenital talipes equinovarus who attended the Orthopedics OPD of our hospital (March 2013 to 2016) were taken up. In neonates with delicate skin, the passive manipulation was demonstrated to the mother which they did 5-6 times daily. The application of plaster of Paris cast and passive manipulation was done every 15<sup>th</sup> day upto 3 months of age. After the 3-month age, passive manipulation was done every 3 weeks. If no normalization, surgery was advised and done to correct the resistant component accordingly. All the analyses were performed in R-programming language (R- 3.0.0).<strong></strong></p><p class="abstract"><strong>Results:</strong> 6 cases,10 feet were lost during follow-up. Results were assessed in 134 feet, 128 cases managed conservatively, 13 surgically. Results were assessed according to clinical, radiological criteria of Beatson and Pearson. 13 feet were operated of 144 feet,11 cases posteromedial soft tissue release (PMSTR) was done. In two Joshi’s external stabilizing system (JESS) fixator was applied.</p><p class="abstract"><strong>Conclusions:</strong> Majority of cases can be treated successfully by conservative means and only in 11 cases PMSTR was done, 2 cases of relapsed feet JESS was applied.</p>Navneet GoelAshish GoyalMohit Sharma
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226348048610.18203/issn.2455-4510.IntJResOrthop20201729Influence of posterior tibial slope on knee flexion in posterior stabilized fixed bearing primary total knee arthroplastyhttps://www.ijoro.org/index.php/ijoro/article/view/1495
<p class="abstract"><strong>Background:</strong> The goal of total knee arthroplasty (TKA) is to relieve pain and maintain stable range of motion (ROM) for day to day activities. Among the various factors, posterior tibial slope slope (PTS) may play an important role in achieving good postoperative knee flexion. Our study aims to know the effectiveness of PTS on the ROM of the knee in a posterior cruciate ligament (PCL)-substituting TKA.</p><p class="abstract"><strong>Methods:</strong> A total of 125 unilateral PCL-substituting TKA’s were included in the study. Based on postoperative PTA which was measured on lateral radiograph, patients were divided into 3 groups, Group A (PTS of ≤2) comprise of 24 patients. Group B consists of 91 patients (PTS of 3 to 7). Group C includes 10 patients (PTS of 8 or more). Functional outcome was measured by using knee society score (KSS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) which were evaluated preoperatively and at 18months post operatively.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean postop ROM was 92.91 ± 10.632; 107.24±10.905; 107.49±13.944 in group A, B, C respectively which was significantly related to mean postop PTS (0.74; 5.62; 9.87 in group A, B, C respectively) (P&lt;0.05). Functional outcome was measured by KSS and WOMAC which showed no significant difference pre and postoperatively.</p><p class="abstract"><strong>Conclusions:</strong> The results of our study validate the hypothesis that a positive correlation exists between the postoperative flexion and PTS in the PCL-substituting TKA, an increase in PTS can lead to a greater degree of the knee flexion for every extra degree of PTS.</p><p> </p>Sandeep Kumar KanugulaMallesh RathodVenugopal S. M.Mohan Babu Lebaku
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226348749110.18203/issn.2455-4510.IntJResOrthop20201018A comparative study of clinical and radiological outcome between cages and morselized bone graft in transforaminal lumbar interbody fusion surgery: a hospital-based studyhttps://www.ijoro.org/index.php/ijoro/article/view/1517
<p class="abstract"><strong>Background:</strong> Degenerative spinal diseases resulting in neuropathic backache are managed by nerve root decompression with instrumented interbody fusion is the treatment of choice for these groups of patients when not managed conservatively.</p><p class="abstract"><strong>Methods:</strong> Hospital based, comparative, retrospective study was carried out in such patients who underwent transforaminal lumbar interbody fusion (TLIF) with either cage with bone graft or stand-alone autologous morselized bone graft. The clinical and radiological outcomes were compared in these two methods of interbody fusion to assess any significant difference between them. A total of 20 patients with lumbar canal stenosis and degenerative grade 1/2 spondylolisthesis who failed conservative management were operated by TLIF approach and were evaluated for post-operative improvement in Oswestry disability index (ODI) and interbody fusion on imaging at 6 months and 1 year postoperatively. Vertebral level of surgical intervention, intra-operative blood loss and duration of surgery were recorded for each patient along with complications, if any.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study there was no significant difference in the clinical and radiological outcome between the two methods of interbody fusion. Although the group which was offered morselized bone graft with cage showed slightly better clinical outcome at 6 months of follow up, both showed no significant difference in ODI at 1 year of follow up.</p><p class="abstract"><strong>Conclusions:</strong> With this study, we can conclude that both the methods have similar clinical and radiological outcome with similar patient satisfaction and can be interchangeably employed for interbody fusion according to surgeon’s and patient’s preferences.</p>Amit JainAbhishek ChandraAakanksha AgarwalRamesh Chandra MeenaMudit Agarwal
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226349249810.18203/issn.2455-4510.IntJResOrthop20201492Evaluation of functional outcome of bucket handle medial meniscus repair along with anterior cruciate ligament reconstructionhttps://www.ijoro.org/index.php/ijoro/article/view/1528
<p class="abstract"><strong>Background:</strong> Bucket-handle meniscus tears (BHMT) are often displaced and unstable and comprise nearly 10% of all meniscus tears and commonly affect the young male population. Displacement of the free segment can lead to significant pain and disability, necessitating reduction and surgical treatment. The aim of present prospective longitudinal cohort study was to evaluate the functional outcomes of bucket handle medial meniscus repair along with anterior cruciate ligament (ACL) reconstruction at 2 years follow up.</p><p class="abstract"><strong>Methods:</strong> Between January 2017 to December 2018, 30 patients who underwent ACL reconstruction along with bucket handle medial meniscus repair were included in the study. Meniscus repair was done using the all inside, outside in, inside out or hybrid techniques. All patients were evaluated clinically at pre op and at 2 year follow up using knee injury and osteoarthritis outcome score and compared. Meniscal healing was assessed clinically using Barrett’s criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> The study comprised 30 patients with a mean age of 27.47 years (range from 13 to 49 years) with 66.67% males. According to clinical examination and Barrett criteria’s the clinical failure rate was 6.67% (2 out of 30 patients) who underwent partial menisectomy later. We also compared functional outcomes of sedentary and active peoplesand also between meniscal repair of less than 3 cm and more than 3 cm’s. There was no statistically significant difference in the functional outcomes in both the groups; however range of motion was significantly higher in tear length 3 cm or less compared to more than 3 cm.</p><p class="abstract"><strong>Conclusions:</strong> Meniscal repair should be aggressively considered in young pa­tients to enhance functional recovery and durability of the knee joint, if the meniscus is reparable.</p>Akshay JainAdhir JainManjeet SinghPrateek Pathak
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226349950510.18203/issn.2455-4510.IntJResOrthop20201485Is surgery the only option for unstable ankle fracture?https://www.ijoro.org/index.php/ijoro/article/view/1537
<p class="abstract"><strong>Background:</strong> Ankle fracture is one of the most common injuries in sports and daily activity. Unstable ankle fracture that are displaced fracture of the lateral malleolus and most bimalleolar or trimalleolar fractures need surgical reduction and fixation.</p><p class="abstract"><strong>Methods:</strong> It is a single centre study in which all unstable ankle fracture above the age of 18 and not associated with any other injury were included in the study. Following fixation patients were followed up at 6 weeks, 3 months and 6 months and functional outcome was assessed with American Orthopaedic Foot and Ankle score (AOFAS).<strong></strong></p><p class="abstract"><strong>Results:</strong> Supination external rotation injury was most common type. Mean AOFAS score at the end of six months was found to be best in supination adduction type. Posterior malleolus fixation with screw were found to have maximum AOFAS score.</p><p class="abstract"><strong>Conclusions:</strong> Surgical outcome in unstable ankle fracture are proved to have good functional outcome.</p>Marikannan C.Dorai Kumar R.Mohan Choudary B.Thirunthaiyan M. R.Tarun Prashanth K. R.
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226350651010.18203/issn.2455-4510.IntJResOrthop20201538Prospective study to assess functional outcomes in patients undergoing single bundle arthroscopic reconstruction of primary anterior cruciate ligament tear comparing with bone quadriceps tendon versus hamstring tendon autografthttps://www.ijoro.org/index.php/ijoro/article/view/1542
<p class="abstract"><strong>Background:</strong> Anterior cruciate ligament (ACL) injuries are one of the most common ligament injuries of knee. Arthroscopic ACL reconstruction has become the standard of care for ACL injuries in the active patient. In present study good bone quadriceps tendon (BQT) autograft and hamstring tendon (HT) autograft will be used for primary arthroscopic ACL reconstruction and its data regarding clinical and functional results will be evaluated and compared.</p><p class="abstract"><strong>Methods:</strong> Sixty patients underwent isolated ACL reconstruction. 30 underwent ACL reconstruction with the BQT and 30 with the HT. The same surgical technique, fixation method and postoperative protocol were used in both groups. Functional outcome in terms of International Knee Documentation Committee (IKDC) score, joint stability (anterior drawer, Lachman, pivot shift), anterior knee pain and isokinetic strength was evaluated.<strong></strong></p><p class="abstract"><strong>Results:</strong> IKDC score in bone quadriceps tendon and hamstring tendon group after 9 months follow up showing no statistical significance. The negative Lachman component was higher in the BQT group than in the HT group. There was no difference between groups in terms of isokinetic strength.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows no statistically significant difference between both groups.</p>Gagan KhannaRaman AttriRohit Sharma
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226351151410.18203/issn.2455-4510.IntJResOrthop20201528A clinico-radiological evaluation of functional outcome of proximal fibular osteotomy for medial compartment knee osteoarthritis: a new emerging techniquehttps://www.ijoro.org/index.php/ijoro/article/view/1425
<p class="abstract"><strong>Background:</strong> The medial compartmental osteoarthritis (OA) knee is initially treated conservatively followed by lateral close/open medial wedge high tibial osteotomy (HTO), or by unicompartmental or total knee replacement (UKR/TKR). Though HTO and UKR/TKR yield good results but are technically more demanding and are fraught with risk of complications, moreover replacement may not be the treatment of choice for younger patients. The objective of this study was to evaluate the efficacy of proximal fibular osteotomy (PFO), a minimally invasive procedure minus risks associated with HTO/TKR.</p><p class="abstract"><strong>Methods:</strong> Thirty-eight patients, 15 males and 23 females with a mean age of 54.46 years (range, 35 to 80 years) underwent PFO for OA knee and were followed for a mean period of 8.63 months (range 6 to 12 months).<strong></strong></p><p class="abstract"><strong>Results:</strong> After PFO all patients experienced immediate significant relief in medial knee pain with improved walking distance. Postoperatively, all patients showed radiological improvement in femorotibial angle (FTA), medial/lateral joint space ratio.</p><p class="abstract"><strong>Conclusions:</strong> PFO is safe, minimally invasive technique with minimal complications. It gives immediate relief of medial knee pain with improved function of joint.</p>Arun VashishtGaurav MenwalRachit Bhatnagar
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226351552010.18203/issn.2455-4510.IntJResOrthop20201725Complex foot deformity and Illizarov technique: a record-based studyhttps://www.ijoro.org/index.php/ijoro/article/view/1546
<p class="abstract"><strong>Background:</strong> Complex foot deformities may occur as a result of trauma, poliomyelitis, osteomyelitis, burn contractures, neuromuscular diseases or may present as a resistant congenital contracture such as clubfoot. The Ilizarov fixator is new and more efficient method in the treatment of orthopedic foot problems. The aim of the study was to assess the outcome of Illizarov technique.</p><p class="abstract"><strong>Methods:</strong> This is a hospital record-based study conducted in 32 patients of foot deformity at orthopedic ward of Navodaya Medical college and Hospital, Raichur. The record- based data was collected in January to July 2019. Data analysis done with SPSS 24.0 version IBM USA.<strong></strong></p><p class="abstract"><strong>Results:</strong> Majority of the subjects were from 0 to 5 years age group i.e. 14 (43.8%). Mean age was 26.2±4.9 years. Majority in our study were males i.e. 71.9%. In majority of the cases, the cause of foot deformity was neglected and relapsed club foot i.e. 12 (37.5%). Treatment period was 22±7 weeks. </p><p class="abstract"><strong>Conclusions:</strong> The Ilizarov method can successfully correct complex foot deformities. Success rate was 90.6%.</p>Naveen Kumar S.Anirudh C. KulkarniArun K. NayakRoshan KumarAlvin SajanAnant A. Takalkar
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226352152410.18203/issn.2455-4510.IntJResOrthop20201558Randomized control trial comparing the functional outcomes of dynamic hip screw and locking plate dynamic hip screw in intertrochanteric fractures of femurhttps://www.ijoro.org/index.php/ijoro/article/view/1497
<p class="abstract"><strong>Background:</strong> The objective of the study was to compare the functional outcomes of intertrochanteric fractures of the femur treated with dynamic hip screw (DHS) and locking plate DHS in elderly.</p><p class="abstract"><strong>Methods:</strong> 48 participants (23 in DHS and 25 in locking plate DHS) aged ≥ 50 years with intertrochanteric fracture of femur were enrolled in the present randomized open label parallel group trial conducted at Pushpagiri Institute of Medical Sciences and Research Centre during a period of 1 year. Open, pathological, other fractures in the same limb and participants with neurological involvement were excluded. Standard of care (pre and post-operative care) was given to all participants. Sociodemographic, radiological findings, fracture type and Singh’s index were recorded at baseline, 6 weeks, 3 and 6 months. Study commenced after approval from Institutional Ethics Committee and written informed consent was obtained from all study participants. Participants were randomized in 1:1 ratio using coin flip method. Quantitative variables were expressed means and medians and qualitative variables were expressed as proportions. Tests of significance were independent sample t test, Mann Whitney U test, Friedman test and Chi square test.<strong></strong></p><p class="abstract"><strong>Results:</strong> Between DHS and locking plate DHS, no significant difference in baseline parameters, neck shaft angle, tip apex distance, shortening, Harris hip score, range of motion score and length of hospital stay were observed.</p><p class="abstract"><strong>Conclusions:</strong> The functional outcomes and complications between DHS and locking plate DHS were not significantly different.</p>Kiran RamachandranDileep SasidharanOommen Mathew
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226352553010.18203/issn.2455-4510.IntJResOrthop20201090Is Indian osteoarthritis different? Emerging scenarios of disease pattern and implications for diagnosis and treatment of osteoarthritis in Indiahttps://www.ijoro.org/index.php/ijoro/article/view/1393
<p class="abstract"><strong>Background:</strong> There are many studies to show comparative cartilage wear of medial and lateral compartment of knee. However, there are no studies in Indians that compare relative cartilage loss between femur and tibia.</p><p class="abstract"><strong>Methods:</strong> 44 patients with osteoarthritic knee at our center were posted for operative intervention in the form of partial or total knee arthroplasty and included in this study. Each patient had an magnetic resonance imaging (MRI) (cartogram) and weight bearing X-rays of the same knee. Intraoperative qualitative cartilage loss both femoral and tibial surfaces was observed and confirmed with preop findings of cartilage loss on X-ray or MRI.<strong></strong></p><p class="abstract"><strong>Results:</strong> The wear/loss of cartilage in 44 patients in femur is approximately twice that of tibia.</p><p class="abstract"><strong>Conclusions:</strong> Femoral cartilage loss is significantly more than tibia in Indians. These findings carry significance of not waiting for bone on bone arthritis to consider active treatment for Indian osteoarthritis patients. Bone on bone arthritis has so far been considered the litmus test for any intervention for osteoarthritis, even in India. Specific attention should rather be given to the femoral condyle clinically and radiologically. The authors have already described “The Dervan RIM sign” for the same purpose. The wear pattern is different from Caucasians and focus cannot be on joint space narrowing which is only with equally prevalent tibial and femoral cartilage wear.</p><p class="abstract"> </p>Pavankumar KohliHanumant WaybasePoorv PatelL. G. NaikRajiv ColacoSunil NadkarniSatishchandra Gore
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226353153510.18203/issn.2455-4510.IntJResOrthop20201723The prospective analysis of functional outcome of osteosynthesis of extra-articular distal tibia fractures using minimally invasive percutaneous plate osteosynthesis techniquehttps://www.ijoro.org/index.php/ijoro/article/view/1549
<p class="abstract"><strong>Background:</strong> Extra-articular distal tibial fractures are one of the most complicated ones to treat, specially comminuted fractures. Its subcutaneous nature and lack of adequate musculature makes it more prone for soft tissue damage and bone loss. The key to handle these troubling fractures is to skilfully preserve and reconstruct the soft tissues, early mobilisation and functional use of the extremity with the maintenance of satisfactory length and alignment of the fracture.</p><p class="abstract"><strong>Methods:</strong> This prospective longitudinal study involved 30 patients with extraarticular distal tibia fracture, who are admitted in Vydehi Institute of Medical Sciences and Research Centre between January 2017 to 2019. All were treated with closed reduction and internal fixation using pre-contoured anatomical distal tibia locking plate using minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Functional and radiological outcome along with associated complications are evaluated in serial follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> 30 patients with minimal follow up criteria of 6 months was evaluated with AOFAS score for functional outcome. At the end of 1 year, 21 cases (70%) of the cases had excellent results, 5 cases (16.7%) had good results, 3 cases had fair results and only 1 case had poor result.</p><p class="abstract"><strong>Conclusions:</strong> With the use of pre-contoured anatomical locking plates used, MIPPO technique is effective in extra articular distal tibia fractures where it not only helps in decreasing operating time but also in achieving excellent functional outcome with radiological union the fractures by preserving osseous vascularity and minimal soft tissue insult due to surgery.</p>Arjun MandriNuthan JagadeeshSunil NanjareddyVishwanath Muttagaduru Shivalingappa
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226353654110.18203/issn.2455-4510.IntJResOrthop20201555Burden of isolated clavicle fractures at tertiary care healthcare centre: a look into registryhttps://www.ijoro.org/index.php/ijoro/article/view/1418
<p class="abstract"><strong>Background:</strong> Clavicle is one of the common bones to undergo fractures with incidence rate higher in second to third decade of one’s life as well as in elderly age. Management of these clavicle fractures have always been a subject of debate, where literature have been advocating both non-operative as well as operative methods.</p><p class="abstract"><strong>Methods:</strong> The present study was conceived to know the burden of these isolated clavicle fracture cases reporting to tertiary level healthcare institute of North India and to study about their management pattern.<strong></strong></p><p class="abstract"><strong>Results:</strong> During the five years study duration (2014-2018), a total of 38 patients had reported to the trauma centre of the institute. Out of total, males had more preponderance 77% (29) and incidences were reported more in younger population. All patients were managed well by opting conservative measures, besides deformity had been reported in 2 (5.26%) patients. 3 (7.9%) patients had reported with complaints of pain, weakness while doing work, fatigue and pain when lying on the affected shoulder None of the patient was managed by open reduction and fixation.</p><p class="abstract"><strong>Conclusions:</strong> The present study concludes that the number of patients having isolated clavicle fracture are not contributing to any sort of burden at tertiary level institutes and are not even time consuming.</p>Sruti SharmaVishal KumarRaman SharmaSameer Aggarwal
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226354254510.18203/issn.2455-4510.IntJResOrthop20201724Evaluation of outcome of posterior decompression and instrumented fusion in thoracolumbar fractureshttps://www.ijoro.org/index.php/ijoro/article/view/1545
<p class="abstract"><strong>Background:</strong> The fractures of the thoracolumbar junction are the most common injuries of the vertebral column. Fall from a height and road traffic accidents are the main causes of injury. The present study aims to evaluate the functional, neurological and radiological outcome of the posterior decompression and instrumented fusion in operated patients with thoracolumbar fractures.</p><p class="abstract"><strong>Methods:</strong> In this retrospective and prospective study, a cohort of 30 patients with thoracolumbar fractures, classified by thoracolumbar injury classification and severity (TLICS) scoring system, underwent posterior decompression and pedicle screw fixation from January 2013 to August 2018 were included. Patients were assessed functionally (ODI score), neurologically (MRC grading) and radiologically (kyphotic angle) preoperatively and at 6 weeks, 3 months, 6 months and 12 months post-operatively.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean ODI score improved from 87.40 pre-operatively to 13.33 at final follow-up (p value 0.001). The mean kyphotic angle decreased from 24.37 degrees preoperatively to 9.87 degrees postoperatively (p value 0.001) with mean loss of correction of 1.16 degrees at final follow-up. Hip flexors and knee extensors improved from a mean preoperative value of 2.60 to 4.83 at final follow-up (p value 0.001). Similarly, ankle dorsiflexors, long toe extensors and ankle plantar flexors improved from mean preoperative value of 2.53, 2.50 and 2.60 to 3.93, 3.80 and 4.73 at final follow-up, respectively (p value 0.001).</p><p class="abstract"><strong>Conclusions:</strong> Posterior decompression and instrumented fusion is a safe and effective surgical option in patients with thoracolumbar fractures. TLICS scoring system has a prognostic value and helps in determining the prognosis in these patients.</p>Akshay JainUtkarsh AgrawalPronnat JainArjun JainR. K. Jain
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226354655110.18203/issn.2455-4510.IntJResOrthop20201515A study of comparison of tension band wiring versus plating for olecranon fractureshttps://www.ijoro.org/index.php/ijoro/article/view/1437
<p class="abstract"><strong>Background:</strong> Olecranon fractures are one of the common fractures around the elbow, comprising around 37% of all fractures occurring around the elbow. Olecranon fractures are commonly treated with either plating or tension band wiring. The purpose of current study is to compare the clinical and radiological outcome of tension band wiring and plate fixation in patients operated for olecranon fractures.</p><p class="abstract"><strong>Methods:</strong> Current study was conducted in a tertiary care center from May 2017-2019. Study compromises of 30 patients operated for olecranon fractures. Clinical and radiological outcome of patients treated with tension band wiring or plating and assessed using the Mayo’s elbow score at 6 months follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of the 30 patients, 15 were treated with tension band wiring and 15 were treated using open reduction and plating. Out of the 15 operated with tension-band wiring (TBW) K wire on follow up 11 showed excellent score on Mayo elbow score, 2 had good results and 2 had fair results. In patients operated with Plating 12 showed excellent result on follow up and 3 showed good result. No patient had fair or poor score.</p><p class="abstract"><strong>Conclusions:</strong> Both tension band wiring and plate fixation are effective methods for treatment of olecranon fractures however complications regarding symptomatic metal prominence and superficial infection were higher in patients treated with tension band wiring as compared to plate fixations.</p>Dhwanil Chandresh TadaKushal Nikhil ParikhVarun Sanjiv ShahBhagirath Durlabhjibhai Goriya
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226355255510.18203/issn.2455-4510.IntJResOrthop20201726A study on radiological outcomes of accelerometer based hand held navigation system in total knee arthroplastyhttps://www.ijoro.org/index.php/ijoro/article/view/1443
<p class="abstract"><strong>Background:</strong> The goal of obtaining more accurate component alignment in total knee arthroplasty (TKA) has led to the development of techniques like portable accelerometer-based handheld navigation system, computer assisted system, patient specific instrumentation. Among which hand held navigation has showed promising results for achieving accurate resection and alignment and only few studies were done to assess radiological outcome or the effective component alignment using portable accelerometer-based hand held navigation system in TKA.</p><p class="abstract"><strong>Methods:</strong> TKA using portable accelerometer-based hand held navigation system (Smith and Nephew- knee align) was done on 25 knees with primary osteoarthritis. Preoperative and post-operative mechanical axis and component alignments were measured using hip-to-ankle radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the femoral components, 92.0% were placed within 90°±2° to the femoral mechanical axis in the coronal and 96.0% of the tibial components were placed within 90°±2° to the mechanical axis in the coronal plane, 94.3% of the TKAs had an overall lower extremity alignment within 3° of neutral to the mechanical axis, based on postoperative hip-to-ankle radiographs.</p><p class="abstract"><strong>Conclusions:</strong> The degree of accuracy in positioning the femoral and tibial component in TKA using portable accelerometer-based hand held navigation system (knee align) is very much promising and is an effective intraoperative tool for reducing the proportion of outliers for component placement and thus decreasing the chances of instability and early wear and tear of the components in TKA.</p>Hiranyakumar S.Shivaraj NadagoudaVishnu Harikrishnan
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226355656110.18203/issn.2455-4510.IntJResOrthop20201727Comparison between simultaneous versus staged bilateral total knee arthroplasty: a prospective, randomized, controlled studyhttps://www.ijoro.org/index.php/ijoro/article/view/1451
<p class="abstract"><strong>Background:</strong> Bilateral total knee arthroplasty (TKA) is a common procedure nowadays. Although, staging of surgery is a subject of debate. We conducted a study to compare safety and functional outcomes of simultaneous and staged bilateral TKA.</p><p class="abstract"><strong>Methods:</strong> Our study includes total 70 patients of symptomatic severe bilateral osteoarthritis, underwent simultaneous or staged bilateral TKA during 2015 to 2019. 35 patients were randomly allotted for each procedure. The postoperative evaluations were done according to Knee Society Score at one, three, six and 12 months and yearly thereafter for 2 years following a simultaneous bilateral TKA (group A) and the second procedure in the staged bilateral TKA (group B). In the staged group, the patients were followed at monthly intervals until the second procedure. The categorical variables were statistically significant when p value &lt;0.05.<strong></strong></p><p class="abstract"><strong>Results:</strong> As compared to staged procedure (group B), estimated blood loss was significantly less in simultaneous TKA (group A). Although, blood transfusion rate was significantly high in group A. The length of hospital stay was significantly shorter in group A. Overall complication rate (inpatient and/or 90 days readmission) was not significantly higher in group A. Knee infection rate was significantly lower in simultaneous TKA group. There was no revision of surgery and no mortality in any of our study group within 2 years of follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Simultaneous bilateral TKA is safe and cost-effective procedure with acceptable complication rates for bilateral symptomatic end stage knee osteoarthritis.</p>Rajesh Kumar SharmaR. P. Meena
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226356256610.18203/issn.2455-4510.IntJResOrthop20201728Prospective study of the functional outcome of uncemented bipolar hemiarhroplasty in displaced fracture neck of femur in elderlyhttps://www.ijoro.org/index.php/ijoro/article/view/1474
<p class="abstract"><strong>Background:</strong> Hip fractures in older patients are associated with impaired mobility, excess morbidity, mortality and loss of independence. To avoid the drawbacks of internal fixation and for early mobilization, hemiarthroplasty is performed in elderly. The bipolar prosthesis was developed to overcome the shortcomings of the unipolar fixed-head prosthesis. An additional site of motion would be expected to decrease the amount of loosening, dislocation, and head migration. The aim of the study is to assess the functional outcome of the patients with fracture neck of femur treated with bipolar hemiarthroplasty.</p><p class="abstract"><strong>Methods:</strong> In this study, 20 patients above the age of 60 years with acute displaced fracture neck of femur underwent hemireplacement arthroplasty with bipolar prosthesis in Department of Orthopaedics, KIMS, Bangalore. The patients were followed up on 6th, 12th, 18th, 24th week post operatively. Functional outcome was assessed with Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study, mean average age was 72.3 years with predominantly female patients with 75% of the patients with left sided fracture. 95% of the patients had slight or no pain, 85% of patients had slight or no limp. 50% of the patients could walk without support, 65% of the patients could walk a distance of 6 blocks or more. Average Harris hip score was 82%.</p><p class="abstract"><strong>Conclusions:</strong> These results suggest functional outcome following bipolar hemiarthroplasty is good. Early mobilisation, pain free hip and with good level of activity is obtained following bipolar hemiarthroplasty.</p>Radhakrishna A. MallegowdaChannappa T. SeetharamShivanand SundaramJayaram B. SiddegowdaVeeresh Nijalingappa
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226356757310.18203/issn.2455-4510.IntJResOrthop20201736Study of management of subtrochanteric fractures of femur with reconstruction nailhttps://www.ijoro.org/index.php/ijoro/article/view/1473
<p class="abstract"><strong>Background:</strong> Subtrochanteric fractures of femur are the fractures occurring from the inferior aspect of the lesser trochanter to 5 cm distally. They represent a challenge for surgeons due to the deforming forces acting on the region and the high rates of complications like non-union. This study evaluates the fixation of subtrochanteric fractures of femur with reconstruction nail which is a specialized antegrade intramedullary nail for femur.</p><p class="abstract"><strong>Methods:</strong> A prospective study conducted between October 2017 to May 2019 where 20 cases of subtrochanteric fractures of femur were treated with reconstruction nail and were followed up serially till 24 weeks radiologically and clinically.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average time of union for patients was 5.15±1.14 months with 3 patients whose fractures didn’t unite where one went for frank non union, one had a refracture and one patient had reverse z effect. The functional outcome was excellent in 45% patients and good in 30% patients while poor in 3 (15%) patients.</p><p class="abstract"><strong>Conclusions:</strong> Reconstruction nail is a good device for subtrochanteric fractures of femur providing rigid fixation with low complication rates.</p>Shivananda SundaramLokesh MunaiahRadhakrishna A. MallegowdaJayaram B. SiddegowdaJai Aditya Jhamb
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226357458010.18203/issn.2455-4510.IntJResOrthop20201730Prospective comparative study of extra-articular distal tibia fractures-intramedullary nailing versus medial minimally invasive percutaneous platinghttps://www.ijoro.org/index.php/ijoro/article/view/1481
<p class="abstract"><strong>Background:</strong> The distal tibia extra-articular fractures are treated with both intramedullary nailing (IMN) and medial minimally invasive percutaneous plate osteosynthesis (MIPPO). The aim of this study was to compare the results of IMN and medial MIPPO in distal tibia fractures. The complications and secondary interventions in both groups were compared.</p><p class="abstract"><strong>Methods:</strong> Fifty patients with distal tibia were randomly assigned to IMN (group 1) and medial MIPPO group (group 2). The functional outcomes were evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score. Complications like infection, delayed union, non-union, malunion, hardware prominence and secondary interventions were compared.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average union time was 21.12±6.93 weeks in group 1 and 23.56±6.96 weeks in group 2 (p=0.220). The mean AOFAS scoring was 90.76±7.9 in group 1 and 88.4±8.33 in group 2 (p=0.339). Five patients in group 1 and one in group 2 had malalignment. Deep infection was present in one and superficial infection was present in two cases in group 2. None of the patients in group 1 had infections. Three patients in group I developed anterior knee pain and six in group 2 had hardware prominence. Seven cases in IMN group required secondary interventions and fourteen in medial MIPPO group.</p><p class="abstract"><strong>Conclusions:</strong> Extra-articular distal tibia fractures are successfully treated with IMN and medial MIPPO with comparable functional outcomes. Prevalence of malunion was higher in IMN group and hardware prominence was more prevalent in MIPPO group. Implant removal are more in medial MIPPO group mostly due to implant irritation.</p><p class="abstract"> </p>Devendra LakhotiaAshok MeenaMadharam BishnoiKartikeya SharmaPadmakar Shinde
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226358158610.18203/issn.2455-4510.IntJResOrthop20201731Outcome of pedicle screw fixation with transpedicular bone grafting in fracture of thoracolumbar vertebraehttps://www.ijoro.org/index.php/ijoro/article/view/1496
<p class="abstract"><strong>Background:</strong> Posterior short segment instrumentation for thoracolumbar fracture is known for high implant failure rate because of the lack of anterior support. Anterior body augmentation by transpedicular bone grafting has been developed as an alternative to overcome this failure. In this study, we have evaluated the outcome of the cases of the unstable thoracolumbar spine injuries managed surgically with pedicle screws and transpedicular bone grafting.</p><p class="abstract"><strong>Methods:</strong> 20 patients were included in this study and were followed up for up to 6 months postoperatively. We assessed the outcome of each patient with Frankel scale and visual analog score (VAS) post-operatively clinically and radio logically by measuring Cobb’s angle and anterior vertebral body height post-operatively on follow-up at 6 weeks, 12 weeks, and 24 weeks.<strong></strong></p><p class="abstract"><strong>Results:</strong> We found that males had higher incidence with most common mode of injury was fall from height. D12 was single most involved vertebrae. The average Cobb’s angle during preoperative stage was 12 degrees and 22.05 degrees at 6th week and this was maintained till 24th week. The mean difference of anterior vertebral body height between pre-operative and 24th post-operative week was 7.15 mm. The mean VAS pre-operatively was 9.8 which changed to 0.75 at 24 weeks follow up. These were statistically highly significant.</p><p class="abstract"><strong>Conclusions:</strong> Our study established that Pedicle screw fixation with transpedicular bone grafting has a satisfactory result and can restore vertebral height, increase the stability of the injured vertebrae and leads to a significant improvement in the patient’s quality of life.</p>Harpreet SinghAliasgar J. RampurwalaTej S. RudaniMalay P. Gandhi
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226358759210.18203/issn.2455-4510.IntJResOrthop20201732Proximal femoral nail antirotation II in fixation of intertrochanteric fractures: retrospective and prospective observational studyhttps://www.ijoro.org/index.php/ijoro/article/view/1506
<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures occur mostly in elderly patients, and the outcome may be extremely poor if there is prolonged bed-rest. The best treatment for trochanteric fracture remains controversial. Proximal femoral nail antirotation (PFNA) II has excellent fit as the design is adapted to the anatomical situation of small statured patients also. It has a medial lateral angle of 5 degrees. It has several distal locking options viz static/dynamic. Objective of this study was to observe the operating time, blood loss and fracture union in intertrochanteric fractures treated with PFNA II from the data collected from patient’s case sheets and post-operative X-rays.</p><p class="abstract"><strong>Methods:</strong> 25 patients who were operated with PFNA II for unstable intertrochanteric fracture were selected using random selection and following parameters were noted from the records.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age of the participants is 70.72±8.55 years with range from 52 years to 89 years. The mean duration was 1.98 hours ±0.66. The median duration was 2 with interquartile range from 1.5 to 2.5 hours. Mean blood loss was estimated to be 390 ml±62.78. The median blood loss was 370 ml with interquartile range from 360 to 420 ml.</p><p class="abstract"><strong>Conclusions:</strong> The PFNA II is an ideal implant for unstable intertrochanteric fracture since stable intramedullary fixation can be achieved with almost 100% union in the studied population.</p>Arvind Kumar S. M.Arun Kumar B.
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226359359610.18203/issn.2455-4510.IntJResOrthop20201733Low-grade spondylolisthesis: is transforaminal lumbar interbody fusion superior to posterolateral fusionhttps://www.ijoro.org/index.php/ijoro/article/view/1527
<p class="abstract"><strong>Background:</strong> Spondylolisthesis is anterior translation of the cephalad vertebra relative to the adjacent caudal segment. Both posterolateral fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) and have shown high fusion rates with good clinical outcomes. But it is not clear which treatment leads to better outcomes, as limited studies have been done to compare PLF and TLIF in low grade spondylolisthesis. Our objective is to determine whether PLF or TLIF was associated with better clinical and radiological outcomes in patients with low grade spondylolisthesis.</p><p class="abstract"><strong>Methods:</strong> Fourty patients were enrolled and assigned into PLF (n=20) or TLIF (n=20) group. The outcome measures were: clinical outcomes as assessed with a visual analogue scale and the modified Oswestry disability index, the fusion rate based on radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> The improvement of visual analog score (VAS) of low back pain was greater in TLIF than in PLF (89.6% versus 88.7%, p=0.79). The improvement of VAS of leg pain was greater in TLIF than in PLF (96.5% versus 94.8%; p=0.27). The improvement of Oswestry disability index (ODI) was greater in TLIF than in PLF (71.7% vs 69.8%, p=0.32). The fusion rate was 85% in TLIF and 75% in PLF (p=0.43). Overall outcome was excellent in 80% in TLIF compared to 65% in PLF (p=0.29).</p><p class="abstract"><strong>Conclusions:</strong> Fusion rates are higher in TLIF and average functional outcomes (VAS and ODI) were better in TLIF compared to PLF. Larger and longer studies may provide a significant outcome. Based on our results and literature review, we conclude that TLIF is superior to PLF.</p>Hiranya Kumar SeenappaKarthik Narayanamurthy MittemariVamshikrishna Chand Nimmagadda
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226359760210.18203/issn.2455-4510.IntJResOrthop20201734Vitamin D status in Indian subjects: a retrospective analysishttps://www.ijoro.org/index.php/ijoro/article/view/1531
<p class="abstract"><strong>Background:</strong> The objective of the study was to conduct a systematic evaluation of vitamin D status in pan India population, to provide a comprehensive depiction of the vitamin D status among Indians.</p><p class="abstract"><strong>Methods:</strong> This retrospective, cross-sectional, multicentric study considered data of subjects (≥18 years) who underwent 25(OH)D test at vitamin D screening camps, conducted at 229 sites across 81 cities in India. Primary study variables were proportion of subjects with vitamin D (25(OH)D) - severe deficiency (&lt;5 ng/ml)/ deficiency (≥5-&lt;20 ng/m)/ insufficiency (≥20-&lt;30 ng/ml)/ sufficiency (≥30-&lt;150 ng/ml) and toxicity (≥150 ng/ml).<strong></strong></p><p class="abstract"><strong>Results:</strong> Data from 4624 subjects (mean SD) age: 45.4 (14.5 years) was considered for this analysis. A total of 3552 (76.9%) subjects had vitamin D level of &lt;30 ng/ml, including 41 (0.9%) subjects with severe deficiency, 2310 (50.0%) subjects with deficiency and 1201 (26.0%) subjects with insufficiency. Prevalence of vitamin D level of &lt;30 ng/ml was found marginally higher in males (77.3%) than females (76.5%). Analysis of zonal data revealed that prevalence of vitamin D level &lt;30 ng/ml was highest in east India (83.4%) followed by south (81.6%), west (76.3%) and north (73.3%). The incidence of vitamin D level &lt;30 ng/ml was highest in the age-group of ≥18-≤30 years (82.5%), followed by &gt;30-≤ 40 (80.4%), &gt;40-≤50 (76%) and &gt;50-≤65 (74.1%) years groups.</p><p class="abstract"><strong>Conclusions:</strong> Our study indicates a high prevalence of vitamin D deficiency/insufficiency in the Indian population irrespective of sex, age, and location. These clinically identified cases represent only a part of a bigger concern, necessitating the need for optimal public health action.</p>Sanjiv Goel
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226360361010.18203/issn.2455-4510.IntJResOrthop20201735Computed dynography, a method for evaluation of gait pattern in treated cases of congenital talipes equino varushttps://www.ijoro.org/index.php/ijoro/article/view/1488
<p class="abstract"><strong>Background:</strong> Club foot is characterized by inversion, adduction and equinus. Currently, evaluation of children treated for congenital talipes equino varus (CTEV) includes clinical and radiological examination as well as assessment of function. However, none of the methods is ideal. There should<strong> </strong>be objective methods for better evaluation of function in treated CTEV. Gait analysis is the emerging method in objectively assessing the functional outcome. The aim of the study was to compare the selected measures from vertical ground reaction force variables and gait parameters of treated CTEV children with plantigrade feet, to healthy age and gender matched control group.</p><p class="abstract"><strong>Methods:</strong> We took 31 children with treated CTEV with mean age 8.21 years<strong> </strong>and compared with 31 age and gender matched controls. The patients were initially treated under a standard protocol. Gait cycle properties, step time parameters and vertical ground reaction force variables were recorded and comparison of unilateral and bilateral cases of treated CTEV was done with that of controls.<strong></strong></p><p class="abstract"><strong>Results:</strong> Data showed that despite good clinical results and overall function, residual intoeing, lateral foot walking, mild foot drop, weak plantar flexor power, possible residual inversion deformity of the foot, increased frequency and decreased duration of cycle and asymmetry in gait were the main characteristics of gait of children with treated CTEV. In unilateral cases single and double support times were decreased and in bilateral CTEV double support times are increased.</p><p class="abstract"><strong>Conclusions:</strong> The study confirms that in clubfoot patients who underwent full treatment, gait parameters do not reach normal levels. Gait analysis can be used to quantify gait pattern characteristics and is helpful in evaluation and further development of treatment of patients.</p>Akshay JainAdhir JainRavi Kant JainPrateek Pathak
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226361161710.18203/issn.2455-4510.IntJResOrthop20201105Clinical outcomes of intramedullary femoral nailing system to treat femoral fracturehttps://www.ijoro.org/index.php/ijoro/article/view/1485
<p class="abstract"><strong>Background:</strong> Femoral fractures are bone fracture involve femur, common injuries in adults. Intramedullary femoral nailing system is the recommended solution or treatment for fractures due to its high union rates.</p><p class="abstract"><strong>Methods:</strong> In this clinical inspection 30 patients were selected with bone fracture of femur, and treated by using intramedullary femoral nailing system (universal intramedullary cannulated femoral nail, expert femoral nail, gamma nail and retrograde femoral nail) manufactured by Auxein Medical Private Limited, Sonepat, Haryana, India. There are two types of patients used in this study, one is male (n=18) and another female (n=12). Patients physical fitness was also observed through American Society of Anesthesiologist.<strong></strong></p><p class="abstract"><strong>Results:</strong> Outcomes record from the patients using visual analog scale. Follow up of the patients were taken on 1<sup>st</sup> month, 6<sup>th</sup> month, and 12 months. Post-operative outcomes were good with none of the patients showing non-union of fracture site. There were no complications noticed related to intramedullary femoral nailing system in this study and hardware related complications were not encountered in this study also.</p><p class="abstract"><strong>Conclusions:</strong> Intramedullary nailing system provide excellent outcomes with high union and low complication rates in the management of bone fracture involve femoral in patients.</p>Pooja RawatMohit KumarGaurav Luthra
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226361862110.18203/issn.2455-4510.IntJResOrthop20201031A prospective study on functional outcome of uncemented total hip arthroplasty in patients with inflammatory arthropathieshttps://www.ijoro.org/index.php/ijoro/article/view/1533
<p class="abstract"><strong>Background:</strong> Although medical management has improved the outcome and may have reduced the need for surgery, total hip arthroplasty (THA) is often required to manage pain and restore function and mobility. The successful functional outcome of THA in patients with inflammatory arthropathies is essential in understanding the need for THA, and its benefits in those undergoing it. Objective of the study is to evaluate the functional outcome of total hip arthroplasty in patients suffering from inflammatory arthritis using Harris hip score (HHS) and to assess the post operative complication in these patients.</p><p class="abstract"><strong>Methods:</strong> In a prospective study conducted on patients with inflammatory arthritis treated with THA between a study period of January 2018 to January 2020. All the patients after assessing them clinically and radiologically were operated with uncemented THA through posterolateral approach. Functional outcomes of hip were evaluated using HHS at various intervals.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study, patients were followed up to 24 months. About 46.7% of patients were diagnosed with rheumatoid arthritis, 33.3% of patients were diagnosed with ankylosing spondylitis, 20% of patients were diagnosed with sero negative arthritis. 90% of patients had no limb length discrepancy, no other post-operative complications were noted. The final functional outcome of hip according to HHS were 13.3% of excellent, 56.7% good results and 30% of fair results.</p><p class="abstract"><strong>Conclusions:</strong> This study concludes that THA in patients with inflammatory arthritis with restricted activities of life had improved in short term follow up and ease of rehabilitation and return to function.</p>Girish MarappaVishwanath Muttagaduru ShivalingappaNuthan JagadeeshArjun Mandri
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226362262710.18203/issn.2455-4510.IntJResOrthop20201520Coaptation and functional bracing of adolescent humeral shaft spiral fracture: a case report and review of literaturehttps://www.ijoro.org/index.php/ijoro/article/view/1505
<p class="abstract">Adolescent humerus shaft fractures are uncommon. Direct injuries lead to transverse fractures and indirect injuries lead to spiral and most oblique fractures. There is fracture displacement, angulation and internal rotation of the proximal fragment. There is difficulty in maintaining reduction after closed manipulation of spiral fractures. Paediatric humeral shaft fractures are treated by elastic intramedullary nails more often nowadays. We present a case of isolated spiral fracture of the middle1/3rd and distal 1/3rd junction of the humerus shaft with displacement and angulation treated successfully with closed reduction, coaptation U slab followed by functional orthosis.</p>Thiyagarajan Thiagarajan SingaramGiriraj Harshavardhan J.K.
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226362863110.18203/issn.2455-4510.IntJResOrthop20201019Aneurysmal bone cyst in proximal phalanx treated without bone graftinghttps://www.ijoro.org/index.php/ijoro/article/view/1524
<p class="abstract">Aneurysmal bone cyst involving the hand are a rare occurrence especially in the proximal phalanx. We report a case of 5 years old female child with proximal phalanx aneurysmal bone cyst treated without bone grafting. Magnetic resonance imaging may show fluid filled spaces but definite diagnosis can only be obtained histologically. It is a benign lesion still it can involve growth plate hence intervention is necessary. The treatment includes curettage with or without bone grafting.</p>Palanisami R. S.Srinivasan RajappaRaghavendran .
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2020-04-222020-04-226363263410.18203/issn.2455-4510.IntJResOrthop20201550Bilateral symmetrical anterior fracture dislocation of shoulderhttps://www.ijoro.org/index.php/ijoro/article/view/1482
<p>The incidence of simultaneous bilateral shoulder joint dislocation is rare and is almost always posterior usually caused by violent muscle contraction as in patients with seizure disorders or who experience electric shock or undergo electroconvulsive therapy. simultaneous bilateral fracture-dislocation is even rarer, with a few cases reported in the literature. We report an unusual case with dislocation of the both shoulder joints in anterior direction after a seizure episode, With symmetrical unifocal 2-part extraarticular vertical fracture of proximal end segment of humerus (11A3) both sides. Although there have been a few reports of bilateral symmetrical fracture dislocations of the shoulder in the past, an injury pattern resembling our case has, to the best of our knowledge, not been described in the literature so far. Our report describes regarding the mechanism of injury in a case of a bilateral symmetrical anterior fracture dislocation following a seizure episode that treated with open reduction internal fixation using proximal humerus internal locking system (PHILOS). At final follow-up, the patient had healed fractures, painless near normal range of motion.</p>Yogendra KumarShashi Kul BhaskarBharti LalVijendra Gahnolia
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226363563710.18203/issn.2455-4510.IntJResOrthop20201737Endoscopy assisted extended curettage in a rare case of aneurysmal bone cyst involving the 2nd metatarsal of a childhttps://www.ijoro.org/index.php/ijoro/article/view/1487
<p>Aneurysmal bone cysts account for only 1% of all bone tumours and of these only a handful of reported cases occur in the foot. They can mimic other bone tumours on imaging studies, thus making histological diagnosis mandatory. Aneurysmal bone cyst of a metatarsal is very rare especially in children and only few cases have been reported in the literature. We report the novel management option for a rare case of an Aneurysmal bone cyst localized to the second metatarsal in a 5 years old boy who presented with limping, local pain, and minimal swelling in his left foot. Tissue diagnosis was confirmed on the basis of needle biopsy. Surgery was in the form of extended curettage using an endoscope with a high-speed burr and cautery. The remnant cavity was filled up with artificial bone graft. Histopathology analysis of the resected tissue was consistent with Aneurysmal bone cyst. There was complete healing at final follow-up at 2 years. Endoscopy assisted extended curettage appears to be an ideal treatment option as it provides a perfect visualisation of the interior of the entire cyst and use of cautery and burr more accurately under direct vision which potentially leaves only a minimal scope for recurrence. Use of artificial bone grafts instead of conventional autogenous bone grafts to reduce graft site morbidity in children and stimulate local foreign body reaction for enhancing residual tumour cell kill if any and also to promote bony sclerosis for healing.</p>Bhaskar BorgohainKashif A. AhmedTashi G. Khonglah
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226363864210.18203/issn.2455-4510.IntJResOrthop20201738Tarlov cyst- a rare occurrence: a short series of two caseshttps://www.ijoro.org/index.php/ijoro/article/view/1423
<p>Tarlov cysts were first noted and described by Tarlov in 1938. The overall incidence of these is somewhere between 08%-09% of the total population with female preponderance. Most commonly, they are in sacral region. Patients were either asymptomatic or reported in the OPD with low backache with radiculopathy CT guided micro fenestration of the cyst was done using the aspiration-injection technique in the symptomatic patient. The primary outcomes, pain and function, were assessed by using the lumbar spine outcomes questionnaire. The outcome in our cases was excellent in terms of pain intensity, personal care, lifting, walking, sitting etc., requiring no further surgical intervention.</p>Kamal Kumar AroraPriti Chaudhary
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226364364810.18203/issn.2455-4510.IntJResOrthop20201739Arthroscopic assisted fixation of central depressed lateral tibial plateau fracture: case reporthttps://www.ijoro.org/index.php/ijoro/article/view/1525
<p>Arthroscopic assisted fixation has become the gold standard for managing Schatzker III tibial plateau fractures. There are different techniques available to reduce and fix the central depression. We present one such case of a 41 years old female who had good outcome following arthroscopic assisted fixation using anterior cruciate ligament guide, dilators and calcium hydroxyapatite bone substitute.</p>Vijay ShankarShyam SundarDavid V. Rajan
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226364965110.18203/issn.2455-4510.IntJResOrthop20201740An illustrative case report emphasizing the biological plating of a comminuted intra-articular fracturehttps://www.ijoro.org/index.php/ijoro/article/view/1510
<p class="abstract">Comminuted intra-articular fractures are very common in high energy traumas, conventional open reduction and plate fixation has been associated with many complications as they disturb the fracture biology and hence minimally invasive plating came into existence. We are reporting a 17 year old boy who met with road traffic accident sustained an AO type 33C2 injury to left femur with severe metaphyseal comminution treated by minimal invasive plate osteosynthesis technique who achieved full radiological union at the end of 4 months and full functional recovery at 8 months follow-up. This case emphasizes the need for preservation of fracture biology which is of paramount importance in healing of comminuted fractures.</p>Vignesh V.J. K. Giriraj Harshavardhan
Copyright (c) 2020 International Journal of Research in Orthopaedics
2020-04-222020-04-226365265410.18203/issn.2455-4510.IntJResOrthop20201048